Dunford et al 2003 - Transient hypoxia

Question 1

Summarise the Dunford et al 2003 paper

Answer 1

Published in the ‘Annals of Emergency Medicine’

Designed to determine the incidence of desaturation and pulse rate reactivity when being intubated by paramedics for severe head injury (GCS<8)

Subset of a Paramedic RSI study

Paramedics had had home-study, written pre-test and 7 hours of instruction

All patients were pre-oxygenated for 60 seconds
Midaz/sux induction, Midaz/Roc once tibe position confirmed

Max three 30 second attempts then SGA

Primary outcomes desaturation pulse rate up or down

57% had significant desaturation, often being prolonged and deep

Authors explain it as poor pre-o2 or longer than 30 second attempts, unclear if they pre-oxygenate in between attempts

Makes the case for highly trained and drilled teams to mitigate dangers of intubation